Depression is a mood disorder that affects over 20 million people annually and is caused by genetic, biological, environmental, and psychological factors. Major depression lasts over two weeks and is characterized by feelings of sadness and loss of interest. Bipolar disorder involves cycles of mania and depression. Mania is a mental illness marked by periods of euphoria, delusions, and overactivity. Treatments for depression include antidepressants and psychotherapy, while mood stabilizers and anticonvulsants are used to treat mania.

1. DEPRESSION AND
MANIA
BY
A.PAVITHRA

2. DEPRESSION
• DEFINITION: It is a group of conditions associated with the
elevation or lowering of a persons mood.
• Depression is the most common mood disorder affecting
approximately 20 million people each year.

3. Factors causing depression
• Generally there is no particular evidence or cause for depression.
• But some factors that may contribute to its development are:
• Psychological
• Biological
• Environment

4. • Some evidences also shows that some people with a genetic predisposition to
major depression vulnerable to the disorder.
• But however not everyone with a family history develops depression.
• Some life events that may trigger episodes of depression:
• Death of a loved one
• Major loss or change
• Chronic stress

5. • Alcohol and drug abuse
• medications

6. Types of depression
• MAJOR DEPRESSION: symptoms of depression that last for more than 2weeks.
• DYSTHYMIA: a low mood occurring for at least 2 years along with at least two
other symptoms of depression.
• BIPOLAR DISORDER OR MANIC – DEPRESSIVE ILLNESS: cycles of mood
swings from mania to depression occur.
• SEASONAL AFFECTIVE DISORDER: depression during the winter months
when daylength is short.

7. • POST PARTUM DEPRESSION: Can occur soon after child birth .
• Hormonal and life style changes.
• A TYPICAL DEPRESSION: Improved mood when exposed to pleasurable
positive events
• Increased weight, oversleeping, anxiety, rejection sensitivity.

8. EPIDEMIOLOGY
• Globally more than 350 million people of all ages suffer from depression. (WHO)
• For the age group 15-44 major depression is the leading cause of disability in the
U.S.
• Women are nearly twice as likely to suffer from a major depressive disorder than
men .
• With age the symptoms of depression become even more severe.
• About thirty percent of people with depressive illness attempt suicide.

9. ETIOLOGY
• Genetic cause
• • Environmental factors
• • Biochemical factors : Biochemical theory of depression postulates a deficiency
of neurotransmitters in certain areas of the brain (noradrenaline, serotonin, and
dopamine).
• • Dopaminergic activity : reduced in case of depression, over activity in mania.
• • Endocrine factors

10. • - hypothyroidism, cushing’s syndrome etc
• Abuse of Drugs or Alcohol
• • Hormone Level Changes
• • Physical illness and side effects of medications

12. PATHOPHYSIOLOGY
• DOPAMINE HYPOTHESIS:
• In CNS the neural circuits gets constricted
• |
• Dopaminergic decreased production or dopamine easy uptake
• less dopamine levels in CNS
• Depression

13. • The Serotonin-only Hypothesis - emphasizes the role
of serotonin in depression and downplays noradrenaline.
• - But the serotonin-only theory has shortcomings:
• - it does not explain why there is a delay in onset of clinical
relief
• - it does not explain the role of NA in depression

14. • PERMISSIVE HYPOTHESIS:
• It suggest that low levels of serotonin [5-HT] have a permissive role in the
development of affective disorder.
• The causative neurotransmitter is nor-adrenaline deficit of which causes
depression and functional excess causes mania.
• Increasing 5-HT level in brain corrects the affective disorders by removing the
permissive effect of low 5-HT.

15. • NEUROENDOCRINE HYPOTHESIS:
• Their mechanism of action focus on the monoamine hypothesis for depression
which centers on the disruption of serotonergic, noradrenergic, and
dopaminergic neurotransmission in the brain.
• It includes changes in the hypothalamic – pituitary-adrenal and thyroid axes in
growth hormone and prolactin secrection.

16. RISK FACTORS
• Thyroid diseases
• Diabetes
• Carcinoma
• Pernicious anaemia
• Neurological disorders
• Viral illness
• Heart diseases

17. TREATMENT
• MAO INHIBITORS: Isocarboxazid , phenelzine , tranylcypromine
• TCAs [ Tricyclic antidepressants]:
• Selective serotonin reuptake inhibitors
• A typical antidepressants : venlafaxine , duloxetine
• NON PHARMACOLOGICAL THERAPY:
• Stress reduction
• Social support

18. • Sufficient sleep
• psycotherapy

19. MANIA

20. MANIA
• DEFINITION: A mental illness marked by periods of great
excitement or euphoria , delusions, and overactivity.

21. SIGNS AND SYMPTOMS
• Increased activity, energy, or agitation
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Agressiveness
• Flight of ideas
• Weight loss

22. TREATMENT
• MOOD STABILIZERS: lithium , carbamazepine
• ANTICONVULSANTS; gabapentine , lamotrigine
• BENZODIAZEPINES: lorazepam , clonazepam